NPIMap

Organization Active NPI

Waco Wound Care, PLLC

  • Family Medicine Physician
  • Waco, TX
National Provider Identifier
1548057425
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WACO WOUND CARE, PLLC
Practice address
1300 Lake Air Dr Ste 7
Waco, TX 76710-4452
Phone
(254) 744-5877
NPI assigned
Apr 23, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Slover
Title
Office Manager
Phone
(254) 744-5877

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1300 Lake Air Dr Ste 7
Waco, TX 76710-4452

Mailing address

1300 Lake Air Dr Ste 7
Waco, TX 76710-4452

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250718003575 TX Part B Supplier - Clinic/Group Practice 5395251110 Receives reassigned benefits from 1 practitioner
Practice locations: Waco, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1548057425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 LAKE AIR DR STE 7",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767104452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 LAKE AIR DR STE 7",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767104452",
            "telephone_number": "254-744-5877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACO WOUND CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-23",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "SLOVER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "254-744-5877"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.